Ospedale Pediatrico Bambino Gesú, IRCCS—Emergency Department, Rome, Italy (E. Conicella, U. Raucci, A. Reale, N. Pirozzi); Headache Center, Division of Neurology, Ospedale Pediatrico Bambino Gesú, IRCCS, Rome, Italy (F. Vigevano and M. Valeriani); National Institute of Health—National Centre of Epidemiology, Surveillance and Health Promotion, Rome, Italy (N. Vanacore).
The Child With Headache in a Pediatric Emergency Department
Version of Record online: 6 FEB 2008
© 2008 the Authors. Journal compilation © 2008 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 48, Issue 7, pages 1005–1011, July/August 2008
How to Cite
Conicella, E., Raucci, U., Vanacore, N., Vigevano, F., Reale, A., Pirozzi, N. and Valeriani, M. (2008), The Child With Headache in a Pediatric Emergency Department. Headache: The Journal of Head and Face Pain, 48: 1005–1011. doi: 10.1111/j.1526-4610.2007.01052.x
Conflict of Interest: None
- Issue online: 9 JUL 2008
- Version of Record online: 6 FEB 2008
- Accepted for publication December 10, 2007.
- emergency department
Objectives.— To investigate clinical features of a pediatric population presenting with headache to a pediatric emergency department (ED) and to identify headache characteristics which are more likely associated with serious, life-threatening conditions in distinction from headaches due to more benign processes.
Background.— Although headache is a common problem in children visiting a pediatric ED, a few studies thus far have attempted to identify the clinical characteristics most likely associated with suspected life-threatening disease.
Methods.— A retrospective chart review of all consecutive patients who presented with a chief complaint of headache at ED over a 1-year period was conducted. Etiologies were classified according to the International Headache Society diagnostic criteria 2nd edition.
Results.— Four hundred and thirty-two children (0.8% of the total number of visits) aged from 2 to 18 years (mean age 8.9 years) were enrolled in our study. There were 228 boys (53%) and 204 girls (47%). School-age group was the most represented (66%). The most common cause of headache was upper respiratory tract infections (19.2%). The remaining majority of non-life-threatening headache included migraine (18.5%), posttraumatic headache (5.5%), tension-type headache (4.6%). Serious life-threatening intracranial disorders (4.1%) included meningitis (1.6%), acute hydrocephalus (0.9%), tumors (0.7%). We found several clinical clues which demonstrated a statistically significant correlation with dangerous conditions: pre-school age, recent onset of pain, occipital location, and child's inability to describe the quality of pain and objective neurological signs.
Conclusions.— Differential diagnosis between primary and secondary headaches can be very difficult, especially in an ED setting. The majority of headaches are secondary to respiratory infectious diseases and minor head trauma. Our data allowed us to identify clinical features useful to recognize intracranial life-threatening conditions.